RETIRED LCD Reference Article Billing and Coding Article

Billing and Coding: Implantable Miniature Telescope (IMT)

A57411

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
Retired

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57411
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Implantable Miniature Telescope (IMT)
Article Type
Billing and Coding
Original Effective Date
10/10/2019
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
04/01/2024

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Publications:

CMS Transmittal No. 2479, Publication 100-04, Medicare Claims Processing Manual, Change Request #7854, May 25, 2012, provides billing instructions for HCPCS codes C1840 and 0308T and the deletion of HCPCS code C9732 under the Ambulatory Surgery Center (ASC) Payment System.

CMS Transmittal No. 2481, Publication 100-04, Medicare Claims Processing Manual, Change Request #7844, June 1, 2012 includes CPT code 0308T for an insertion of an ocular telescope prosthesis including removal of crystalline lens which is effective for service performed on or after July 1, 2012.

CMS Transmittal No. 2483, Publication 100-04, Medicare Claims Processing Manual, Change Request #7847, June 8, 2012, provides billing instructions for HCPCS codes C1840 and 0308T and the deletion of HCPCS code C9732 under the Hospital Outpatient Prospective Payment System (OPPS).

CMS Transmittal No. 2378, Publication 100-04, Medicare Claims Processing Manual, Change Request #7682, December 29, 2011, provides billing instructions for HCPCS codes C1840 and C9732 under the Ambulatory Surgery Center (ASC) Payment System.

CMS Transmittal No. 2376, Publication 100-04, Medicare Claims Processing Manual, Change Request #7672, December 29, 2011, provides billing instructions for HCPCS codes C1840 and C9732 under the Hospital Outpatient Prospective Payment System (OPPS).

Article Guidance

Article Text

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Implantable Miniature Telescope (IMT).

Coding Information:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act.

The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

Documentation Requirements:

The patient's medical record must contain documentation that fully supports the medical necessity for services included within the related LCD. This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description

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N/A

Revenue Codes

Code Description

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N/A

CPT/HCPCS Codes

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N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(2 Codes)
Group 1 Paragraph

The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the determination.

The covered ICD-10-CM codes are not meant to exclude patients with a history of exudative macular degeneration now with disciform scarring, but they must no longer be active or require therapy.

Group 1 Codes
Code Description
H35.3114 Nonexudative age-related macular degeneration, right eye, advanced atrophic with subfoveal involvement
H35.3124 Nonexudative age-related macular degeneration, left eye, advanced atrophic with subfoveal involvement
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

Please accept the License to see the codes.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
04/01/2024 R1

Billing and Coding Article A57411 is retired and is no longer in effect for services rendered on or after April 1, 2024. 

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33584 - Implantable Miniature Telescope (IMT)
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
N/A
Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
04/01/2024 10/10/2019 - 04/01/2024 Retired You are here
10/04/2019 10/10/2019 - N/A Superseded View

Keywords

  • Eye
  • Blindness